First Therapy
Posted: Jul 16, 2007
QUESTION:
Dear Dr Young;
For a newly diagnosd HIV positive patient, high viral load, otherwise healthy - patient is very concerned about lipodystrophy cosmetic changes - which will be your therapeutic cocktail choices ? Could you address the balance of efficacy (ie viral load control) versus side effects ? Thanks
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RESPONSE FROM: 
Thanks for your post.
In the recently presented analysis of the ACTG 5142 study, the use of boosted PIs (in this study, lopinavir/ritonavir) was shown to have significantly less risk of the development of lipoatrophy than efavirenz-based regimens (matched for the NRTI pair). Because of this, in patients who are concerned about the genesis of fat changes and are not so concerned about pill number, we tend to favor the use of boosted PIs with 2NRTIs over the lower pill count NNRTI regimens.
In our clinic, this typically falls on the use of fosamprenavir (Lexiva, Telzir) or atazanavir (Reyataz) with ritonavir (Norvir) with either tenofovir/FTC (Truvada) or abacavir/3TC (Epzicom, Kivexa). In my opinion, while all treatment regimens may cause limiting side effects, we haven't found that these newer PIs are any worse tolerated than NNRTIs and offer the benefit of decreased risk of lipo and treatment-emergent drug resistance.
Hope this helps. BY
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